To the Editor: Our recent study of disadvantaged rural residents’ perceptions of and experiences with health care highlighted the critically important role of general practitioners in delivering rural health care. In stage two of the study, assessing rural health and welfare needs,1 we sought out research participants who depended on income from government payments. Interviews identified that most participants and their family members had multiple chronic health concerns and relied on GPs as their local accessible health care providers for acute and ongoing treatment. As one participant noted, “the first port of call is always the doctor”, regardless of the circumstances.

This will come as no surprise to rural GPs, who experience this demand on a daily basis. The shopfront or main-street location, long opening hours, crisis response service, bulk-billing, and no need for referral make the GP’s surgery the ideal health service for people with no money, no transport, and multiple needs.

However, what also came through clearly in the study was that disadvantaged patients normalise poor health as the usual experience. Participants frequently expressed a sense of resignation about the services they received, and they appeared to have low expectations of intervention, other than to relieve immediate pain or distress. For example, a woman with severe gum disease presented for repeated courses of antibiotics because she could not access dental treatment — “There’s no dentist here, but I couldn’t afford it anyway”.

There were many examples where proposed referrals to specialist care could not be accessed by participants because of lack of funds or unavailable specialist services. It is possible, perhaps probable, that the inability of patients to access follow-up services led to them returning to the GP with the same problem over and over again. This may be perceived by the GP as poor self-care, when in fact it is a systemic failure in health care delivery.

Existing health care systems are ineffective in addressing chronic conditions related to deprived social circumstances.2,3 However, as access to care is identified in the Australian Government’s social inclusion agenda as a key factor affecting health status,4 the way general practice facilitates this should not be ignored. The GP is a vital conduit for care within and external to the health system. This gives rural practices significant control of and responsibility for promoting health and welfare services, including preventive care. There is clearly a need for a whole-of-government approach that integrates GP services in a continuum of care.